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Prognosis Good for Separating Siamese Twins

Medicine: Newborn girls are joined only at the abdomen. Physicians at Loma Linda say that increases their chances of surviving surgery to divide them.


LOMA LINDA — A set of Siamese twins was born Wednesday at Loma Linda University Medical Center, and doctors said they expect to successfully separate the girls, who are joined at the abdomen.

The babies share liver tissue, which doctors said can be divided.

Shawna Leilani and Janelle Kiana were delivered by caesarean section and were listed in good condition, weighing 11 pounds, 4 ounces.

Because no other internal organs appear to be shared by the two, "suffice to say we think this is an ideal situation" for successful separation, said Dr. Elmar Sakala, who delivered the twins.

About one birth in 50,000 leads to conjoined twins. Most of those are joined at the chest, creating greater complications. It is rare for both twins to survive, according to medical literature.

On Jan. 12, conjoined twins were born in Tijuana, joined at the abdomen, chest and liver. The girls, Sarah and SarahiMorales, were separated 15 days later at Children's Hospital in San Diego, but Sarahi died an hour later of cardiac arrest.

Shawna and Janelle's parents, Jeff and Michelle Roderick, both 29, of Prescott, Ariz., learned in December that the twins were joined, and prenatal tests indicated that only the liver was shared.

In fact, the infants may have two livers that are connected, rather than just one that is shared, Sakala said, further enhancing their prospects for a healthy recovery.

Jeff Roderick, a high school physical education teacher, said he was initially "jolted," then nonplused when told in December that the embryos were joined.

"My first thought was, 'OK, they're conjoined. What else is wrong with them?' " he said.

When further tests showed no other physical problems and that they could expect otherwise healthy babies, Roderick said he and his wife looked forward to their delivery.

"We had talked about having two children--so it's all finished. We're done," he said.

A hospital videotape of the delivery showed Michelle Roderick, a high school science teacher, smiling broadly during the procedure, which she viewed with the help of an overhead mirror. Afterward, she beamed as she stroked each baby's head as the pair rested.

The twins are expected to go home in several weeks, but then return to Loma Linda for surgery to implant saline solution-filled balloons beneath the skin of their abdomens, in order to stretch the skin to accommodate ultimate separation.

Surgery to separate the babies will not occur for months, doctors said.

The biggest immediate challenge, doctors said, is handling the babies tenderly so that no damage is done to the liver. When they are separated, they may face cardiac and respiratory distress.

"But we really do anticipate a successful separation," said Dr. Gibbs Andrews, who will lead the surgical team.

Sakala, who has delivered more than 5,000 babies--including three previous sets of conjoined twins, none of whom survived because of birth defects--said Wednesday's delivery was thrilling.

"This delivery was truly awesome, truly awe-inspiring," he said. "As we made the incision and delivered two feet, then reached around and found the third foot, we tried to figure out which went with which baby [by seeing] which way the toes were pointing.

"Finally we had four feet," he said. "Now what do you do? You have to get the arms out. Now you have four arms out and four legs out. Normally you rotate the heads, but you can't [in this case]. They're side by side. We were able to get the babies out. The umbilical cord was wrapped around all over the place."

The babies were delivered three weeks short of full term. "We wanted to have a controlled situation, rather than to go into labor in the middle of the night or the weekend," Sakala said.

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